Minimum Case Loads in Visceral Surgery - What Is Crucial: The Surgical Center or the Single Surgeon?

Background: The introduction of a minimum hospital case load in esophageal and pancreatic cancer surgery aimed to decrease postoperative complication rates and improve the long-term prognosis. However, less attention has been paid to the case volume of a single surgeon. Therefore, the aim of this study was to evaluate the influence of individual case volumes in esophageal and pancreatic cancer surgery on postoperative mortality and long-term survival. Methods: To identify scientific articles for this systematic review, a MEDLINE search was performed for studies published between 2004 and 2008. The following keywords were used: esophageal cancer, pancreatic cancer and high volume. Based on the articles identified by this search process, postoperative mortality and long-term survival depending on the single surgeon's case volume was determined. Results: In total, 20 suitable studies were identified, 14 for esophageal cancer and 6 for pancreatic cancer. A significant correlation was found between the case load and postoperative mortality. For esophageal cancer, 10 operations per year were usually classified as 'low volume'. However, a significant reduction of postoperative mortality was just reached when the number of operations was >= 20. Based on the case load numbers of a single surgeon, a difference between high and low volume hospitals was determined in 46% for esophageal and in 53% of pancreatic cancer surgery. Conclusion: We need well educated and trained surgeons that perform surgical therapies in a multidisciplinary team.